Provider Demographics
NPI:1467426981
Name:HOLLADAY, JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:HOLLADAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-686-3542
Mailing Address - Fax:757-686-0230
Practice Address - Street 1:816 INDEPENDENCE BLVD
Practice Address - Street 2:STE 1H
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6010
Practice Address - Country:US
Practice Address - Phone:757-464-2013
Practice Address - Fax:757-464-3046
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232380207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA177407OtherANTHEM
VA541595397OtherTRICARE
VA541595397OtherVIRGINIA HEALTH NETWORK
VA62387OtherSENTARA/OPTIMA
VA005880858Medicaid
VA541595397OtherPRIVATE HEALTHCARE SYSTEM
VA541595397OtherMID ATLANTIC SOLUTIONS
VA4526351OtherAETNA
VA541595397OtherCIGNA
VA177407OtherANTHEM
VA541595397OtherVIRGINIA HEALTH NETWORK